Economic Evaluation of Rehabilitation of Spinal Cord Injury patients in Iran in 2019

Objectives: Despite the various available evidence that rehabilitation interventions are effective for spinal cord injury patients, these interventions usually impose costs on the health system. Therefore, it is necessary to examine the cost-effectiveness of these interventions for the health system of countries through economic evaluation. Based on this, in this study, we have examined the cost-effectiveness and net financial benefits of rehabilitation services in the treatment of spinal cord injury in Iran. Method: Considering that this research is the first complete economic evaluation study related to spinal cord injury rehabilitation, so the first stage of economic evaluation was dedicated to designing an economic evaluation model. The model was designed based on disease groups, natural course of the disease, how and details of rehabilitation interventions for spinal cord injury patients in different disease groups, clinical outcomes, probability of occurrence of outcomes and related costs. The structure of the economic evaluation model of this study is based on the design of a lifetime Markov model with a one-year cycle length for each strategy and two groups of patients (paraplegia and tetraplegia). In this study, we also used the Incremental Cost-Effectiveness Ratio (ICER) to determine the cost of the most effective strategy. All findings were analyzed using Excel 2016 and TreeAge 2011 softwares. Findings: According to the annual incidence of spinal cord injury patients in need of rehabilitation services in the country, which is about two thousand people, based on public sector tariffs, the total annual cost of SCI rehabilitation in Iran in the Paraplegia group from 32,997 to 40,200 Million Rials and in The Tetraplegia group is estimated from 25,476 to 26,119 Million Rials in mild to very severe conditions. Also, the total rehabilitation costs of SCI patients based on public sector tariffs in one year were calculated equal to 256,847 Million Rials. Similarly, based on private sector tariffs, the total annual costs of SCI rehabilitation in the Paraplegia group from 86,374 to 103,122 Million Rials and in the Tetraplegia group from 67,509 to 68,997 Million Rials in mild to very severe cases were estimated. Meanwhile, the total rehabilitation costs of SCI patients were calculated based on private sector tariffs in one year, equivalent to 668,847 Million Rials. Also, the average life-time of SCI patients undergoing rehabilitation is lower compared to non-rehabilitation and also has higher QALY values, which indicates the dominance of the rehabilitation strategy. The amount of ICER in this case is estimated based on public sector tariffs equal to negative 674 Million Rials and based on private sector tariffs equal to negative 629 Million Rials per QALY unit. Possible Sensitivity Analysis of the results and Monte Carlo simulation in both scenarios confirmed the initial analysis findings with high probability. Based on the public sector tariff, the net amount of incremental financial benefits of rehabilitation for the total annual incidence is estimated at 8,991 Billion Rials. These amounts were calculated based on private sector tariffs of 8,579 Billion Rials. Conclusion: Generally, the results of this economic evaluation showed that the rehabilitation of spinal cord injury patients in Iran, based on public and private sector tariffs, is quite cost-effective and has a significant net positive financial benefits. The results of sensitivity analysis also confirmed this finding.